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A six week old boy is presented with a Chlamydia trachomatis pneumonia. This pneumonia is seldom diagnosed because of the mild clinical symptoms and the good prognosis, even without therapy. Diagnosing the Chlamydia trachomatis infection of the neonate is of importance for the mother and the child. Chlamydia trachomatis infections in neonates are an underestimated problem.
Chlamydia trachomatis serovar L1 injected intravenously in mice resulted in systemic nonlethal infections of the animals. Treatment of mice with recombinant murine gamma interferon resulted in a decrease in the number of infectious C. trachomatis organisms recovered from the lungs, spleens, and livers as well as in a decrease of the inflammatory reaction in those organs when assessed 3 and 5 days after challenge.
Recent guidelines issued by the Centers for Disease Control discuss prevention and control of Chlamydia trachomatis infection. Chlamydia trachomatis is the commonest sexually transmitted infection in the United States. The rate of infection has increased in the past 10 years. The guidelines do not discuss control of trachoma and only briefly discuss lymphogranuloma venereum. Education of health care professionals and the public about C. trachomatis is recommended, along with the establishment of a nationwide surveillance system.
Chlamydia trachomatis is now recognized as the most common sexually transmitted disease organism in the United States. Although the potential for vertical transmission of C. trachomatis from pregnant women to their infants is well established, the extent to which infection adversely affects pregnancy and causes perinatal complications remains controversial. We report herein the results of a prospective study of 270 pregnant women with endocervical C. trachomatis compared with 270 matched control subjects (age +/- 1 year, race, and socioeconomic status). Among the entire group (n = 540), the rates of pregnancy complications were: premature rupture of the membranes, 54/270 (10%); preterm delivery, 55 (11%); amnionitis, 20 (4%); intrapartum fever, 23 (4.3%); small for gestational age, 76 (14.5%); postpartum endometritis, 31 (6%); and neonatal sepsis, 10 (1.8%). No statistically significant differences were noted between cases and controls for any of these variables. In the subset of women with recent or invasive chlamydial infection, indicated by the presence of IgM antibody against C. trachomatis, preterm delivery occurred in 13/67 IgM-positive versus 8/99 IgM-negative (p = 0.03) cases. Premature rupture of the membranes was present in 13/67 IgM-positive versus 8/99 IgM-negative (p = 0.03).
Chlamydiae, which are obligate intracellular bacteria, replicate in a nonlysosomal vacuole, termed an inclusion. Although neither the host nor the chlamydial proteins that mediate the intracellular trafficking of the inclusion have been clearly identified, several enhanced green fluorescent protein (GFP)-tagged Rab GTPases, including Rab4A, are recruited to chlamydial inclusions. GFP-Rab4A associates with inclusions in a species-independent fashion by 2 h postinfection by mechanisms that have not yet been elucidated. To test whether chlamydial inclusion membrane proteins (Incs) recruit Rab4 to the inclusion, we screened a collection of chlamydial Incs for their ability to interact with Rab4A by using a yeast two-hybrid assay. From our analysis, we identified a specific interaction between Rab4A and Chlamydia trachomatis Inc CT229, which is expressed during the initial stages of infection. CT229 interacts with only wild-type Rab4A and the constitutively active GTPase-deficient Rab4AQ67L but not with the dominant-negative GDP-restricted Rab4AS22N mutant. To confirm the interaction between CT229 and Rab4A, we demonstrated that DsRed-CT229 colocalized with GFP-Rab4A in HeLa cells and more importantly wild-type and constitutively active GFP-Rab4A colocalized with CT229 at the inclusion membrane in C. trachomatis serovar L2-infected HeLa cells. Taken together, these data suggest that CT229 interacts with and recruits Rab4A to the inclusion membrane and therefore may play a role in regulating the intracellular trafficking or fusogenicity of the chlamydial inclusion.
The role of Chlamydia trachomatis in infections of the male genital tract is reviewed. The organism is an important cause of non-gonococcal urethritis, post-gonococcal urethritis and epididymitis, but does not appear to play a major part in the pathogenesis of chronic abacterial prostatitis or in proctitis in anoreceptive homosexual men.
The antibiotic susceptibility of Chlamydia trachomatis isolates was determined in a tissue culture system. Representatives of all currently recognized serotypes of trachoma-inclusion conjunctivitis agents were tested. Tetracycline and erythromycin yielded similar results, with 1.0 mug/ml preventing chlamydial replication. Rifampin was the most active antibiotic, with 0.25 mug/ml completely suppressing inclusion formation of all strains. Fifty percent end points were usually achieved at one-fourth to one-eighth the 100% suppression level. Penicillin was not as effective, and the assays were often irregular. Antibiotic susceptibility of these chlamydiae was essentially the same, regardless of serotype, anatomic site infected, geographic origin, or antibiotic use in the community.
Chronic Chlamydia trachomatis infection has been demonstrated in the fallopian tubes of asymptomatic infertile women. These women have a significantly increased risk of ectopic pregnancies. The purpose of our study was to determine the efficacy of culturing the ectopic site for C. trachomatis, the likely cause of asymptomatic salpingitis in association with a tubal pregnancy. We cultured the fallopian tubes of 21 patients undergoing surgery for tubal pregnancy, all 21 cultures were negative for C. trachomatis. Although infection with this organism is one of the causes of ectopic pregnancy, we were unable to demonstrate the presence of a concomitant chlamydial infection at the time of surgery. Combining chlamydial cultures with nonculture techniques may be more beneficial in further attempts to demonstrate such an association.
Infections caused by Chlamydia trachomatis are probably the most common sexually transmitted diseases in the United States. Commonly unrecognized and often inadequately treated, chlamydial infections can ascend the reproductive tract and cause pelvic inflammatory disease, which often results in the devastating consequences of infertility, ectopic pregnancy, or chronic pelvic pain. C. trachomatis infections are also known to increase the risk for human immunodeficiency virus infection. The obligate intracellular life cycle of C. trachomatis has traditionally required laboratory diagnostic tests that are technically demanding, labor-intensive, expensive, and difficult to access. In spite of these historical challenges, however, laboratory diagnosis of C. trachomatis has been a rapidly advancing area in which there is presently a wide array of commercial diagnostic technologies, costs, manufacturers. This review describes and compares the diagnostic methods for C. trachomatis infection that are currently approved for use in the United States, including the newest DNA amplification technologies which are yet to be licensed for commercial use. Issues to consider in selecting a test for purposes of screening versus diagnosis based on prevalence, performance, legal, social, and cost issues are also discussed.
To assess the presence of Chlamydia trachomatis in nonacute abacterial prostatitis 30 patients with urethral cultures positive for Chlamydia trachomatis underwent microbiological studies, including cultures of transrectal aspiration biopsies of the prostate. Chlamydia trachomatis was isolated from 10 of the prostatic specimens (33 per cent). In 3 cases a nonspecific cytopathogenic effect caused the destruction of the tissue cultures. Our findings demonstrate that Chlamydia trachomatis may cause ascending infections of the prostate and that this microorganism may have an etiological role in the pathogenesis of nonacute abacterial prostatitis.
In vitro, growth of Chlamydia trachomatis was not entirely eliminated by 960 micrograms of ticarcillin per ml, 64 micrograms of amoxicillin per ml, 32 micrograms of clavulanic acid per ml, a combination of ticarcillin (480 micrograms/ml) and clavulanic acid (32 micrograms/ml), and a combination of amoxicillin (32 micrograms/ml) and clavulanic acid (8 micrograms/ml). However, a greater than or equal to 99% decrease in the number of inclusions was obtained at concentrations readily attainable in serum.
The prevalence of Chlamydia trachomatis infection was 3.78% out of 1,277 volunteer students screened by direct fluorescence assay and Cobas Amplicor PCR. The infection was associated with the nonuse or inconsistent use of condoms in women (P = 0.026) and a previous sexually transmitted infection in men (P = 0.023). The most frequent genotypes determined by sequencing the omp1 genes of 25 clinical isolates were E (44%) and F (20%), and some strains harbored mutations, but E genotype strains did not.
Cervicitis due to Chlamydia trachomatis is common in certain groups of women examined by the authors. It is clinically discrete, having no special characteristics and often not even showing clinical manifestations. However, it is the stage of infection of the genital apparatus which it is desirable to detect in order to prevent the serious tubal complications to which a too large number of young women is subject. Clinical medicine permits diagnosis and prescribes treatment for patients and, if possible, their partners. The principal difficulty is to know when to invoke them.
Chlamydia trachomatis serotype D-K is one of the most important pathogens of communicable diseases. 3 to 5 million new infections are observed annually in the USA. 10% to 30% of young sexually active persons in the age group 15 to 20 years are affected. The organism was isolated from 20% to 30% of patients attending dispensaries for sexually transmitted diseases, 5% to 10% of gynaecological outpatients, 1% to 8% of pregnant women and 0% to 5% of asymptomatic control persons. In men, C. trachomatis was found in 30% to 70% of patients with urethritis (15% to 25% simultaneously with gonorrhoea), in 30% to 60% of persons suffering from nongonoccocal urethritis and in 65% to 70% with postgonoccocal urethritis. 20% of newborns from mothers with positive cultures develop pneumonia and 37% conjunctivitis. Complications such as endometritis, salpingitis, periappendicitis, perihepatitis, ectopic pregnancy, premature birth, proctitis, cystitis, deferenitis, epididymitis, reactive arthritis, morbus Reiter, conjunctivitis, pneumonia (in infants and adults) may cause long lasting disease and may leave behind irreversible sequelae. Treatment with tetracyclines or erythromycin is always effective.
Chlamydia trachomatis was isolated by the irradiated McCoy cell technique from 44 out of 103 men with non-gonorrhoeic urethritis and from 11 out of 15 patients with post-gonococcal urethritis. In women attending the venereal diseases clinics, chlamydial infection was observed in 49 out of 130 patients (38%), an infection incidence of the same order of magnitude as the one noted for gonococcal infection (40%). In 19% both infections occurred simultaneously. Treatment with tetracycline eliminated symptoms and chlamydial infection in almost all cases. The significance of the findings is discussed.
Chlamydia trachomatis infection is common among sexually active populations and often asymptomatic. Infection is associated with complications, including pelvic inflammatory disease and infertility. Using a noninvasive urine ligase chain reaction assay, we determined the prevalence of asymptomatic C. trachomatis infection among sexually active military dependent adolescents and young adults attending clinics at military facilities in San Antonio. The overall prevalence rate was 14%, higher than that reported in many high-risk settings, including sexually transmitted disease clinics. Gender-specific rates were 15% for females and 11% for males. Given a clear cost benefit to screening and treating at-risk populations, we conclude that screening of all sexually active military dependents, both male and female, using this noninvasive test should be performed routinely.
Genital Chlamydia trachomatis infection is the leading cause of bacterial sexually transmitted disease in industrialised countries, particularly among young people. The consequences of chlamydial infection may involve urethritis, cervicitis, pelvic inflammatory disease, ectopic pregnancy, tubal factor infertility, epididymitis and prostatitis. In addition, chlamydial infection increases the risk of acquisition of human immunodeficiency virus and has been associated with cervical cancer. Although screening programmes exist in a number of countries, the continuously increasing prevalence of chlamydial infections demonstrates the necessity for health authorities to establish effective screening policies, and the importance of defining a comprehensive European screening policy is emerging.
BACKGROUND: The new Centers for Disease Control and Prevention treatment guidelines for Chlamydia trachomatis include two recently available drugs, azithromycin and ofloxacin. The best choice for initial therapy remains controversial. OBJECTIVES: We wanted to perform a cost-effectiveness analysis of five different antibiotic regimens for the treatment of uncomplicated Chlamydia trachomatis cervicitis. METHODS: Using information gathered from a MEDLINE search of the English language literature from 1966 to 1994, employing the key words "cervicitis," "C. trachomatis," "erythromycin," "tetracycline," "doxycycline," "ofloxacin," and "azithromycin," we developed a decision analysis model specific for a nonpregnant woman with uncomplicated Chlamydia trachomatis cervicitis. Options in this model included an initially cured infection, a failed initial cure resulting in persistent cervicitis, or pelvic inflammatory disease treated either on an inpatient or outpatient basis. Probability estimates for each option were derived from previously published reports. A cost-effectiveness analysis was performed for three end points: cost per cure with initial therapy, cost per case of pelvic inflammatory disease averted, and cost per hospitalization averted. Sensitivity analyses were done by varying the cure rates for each antibiotic and the complication rates for failed therapy. The costs incurred for treatment were also varied. RESULTS: Using the high estimate for initial cure rates, doxycycline and tetracycline were the most cost-effective agents. Azithromycin was the next most cost-effective agent, followed by ofloxacin and erythromycin. To achieve an equivalent final cost, the probability of initial cure with azithromycin must exceed that of doxycycline by 3 percentage points. As the cost of azithromycin decreases, the difference in initial cure rates between the two drugs to achieve an equivalent final cost becomes smaller. CONCLUSIONS: Doxycycline remains the drug of choice in the treatment of Chlamydia trachomatis cervicitis. The results favor the use of azithromycin rather than doxycycline when there is concern for compliance to the standard doxycycline regimen. A lower cost for azithromycin could favor its use as the drug of choice.